Outcomes Vary by Patient Age, Frailty Following Multiple Myeloma CAR-T

A single center retrospective study of patients with multiple myeloma (MM) who received chimeric antigen receptor (CAR) T-cell therapy has investigated outcome differences by patient age and frailty. It was presented at the 21^st International Myeloma Society Annual Meeting in Rio de Janeiro, Brazil.

“Older patients have higher infection rates post CAR-T. Otherwise, efficacy and toxicity are similar in older versus younger patients. Frail patients have similar response and toxicity, but higher healthcare utilization compared to non-frail patients,” the team of study authors from the Mayo Clinic reported.

The study cohort of 257 patients had a median age of 65 years, 30% was aged 70 years or older, and 42% female. The median follow-up was 1.8 years. 248 patients were older than 60 years, of whom, 33% were frail.

The authors found patients aged younger than 70 years and patients aged 70 years or older both had median progression-free survival (PFS) of one year. Their rates of mortality within 90 days were 4% versus 3%, median overall survival (OS) was 3.8 years versus 2.4 years, and 1-year OS was 83% versus 78%.

Cytokine release syndrome (CRS) incidence was 79% in patients younger than 70 years and 86% in patients 70 years or older. The older cohort had earlier median onset of CRS at one day versus two days (P=.03) and longer median duration at three days versus two days (P=.03).

Immune effector cell associated neurotoxicity syndrome (ICANS) incidence for patients younger than 70 years was 13%, and 21% for patients 70 years or older. Both groups had a median time to ICANS onset of three days and a median duration of two days. Their respective rates of health care utilization were 58% and 64% but the younger group had a lower infection rate at 18% versus 29% (P=.047).

For both frail and non-frail patients, median PFS was one year and the rate of partial responses of very-good-or-better was 78%. Median OS was 2.4 years for frail patients and not reached by non-frail patients (P=.02), and one year OS was 79% versus 82%. Mortality within 90 days was 5% versus 4%.

Frail and non-frail patients had CRS incidence of 86% versus 82%, median time to CRS onset of one versus two days, and both had a median CRS duration of three days. Frail and non-frail patients had no difference in ICANS incidence at 23% versus 18%, but median duration of ICANS was longer in frail patients at three days versus one day (P=.03). Frail patients had higher health care utilization than non-frail patients at 74% versus 56% (P=.02), but infection rates were similar at 31% versus 20%.

Reference

Abdallah N, Elhaj M, Gupta S, et al. Impact of age and frailty on outcomes of patients with multiple myeloma receiving CAR T-Cell therapies – A single center experience. Abstract P-001. Presented at the 21st International Myeloma Society Annual Meeting; September 25-28, 2024; Rio de Janeiro, Brazil.